diff --git a/src/app.rs b/src/app.rs
index b3b1aa6..c7cc1ae 100644
--- a/src/app.rs
+++ b/src/app.rs
@@ -1,4 +1,4 @@
-use crate::pages::{AboutPage, HomePage, LoanerPage, ProviderPortal, ComparisonTestPage, ScholarshipInfoPage, TestPage};
+use crate::pages::{AboutPage, HomePage, LoanerPage, ProviderPortal, ComparisonTestPage, ScholarshipInfoPage, TestPage, ProviderContactPage};
 use leptos::leptos_dom::log;
 use leptos::prelude::*;
 use leptos_meta::{MetaTags, Stylesheet, Title, provide_meta_context};
@@ -105,6 +105,7 @@ pub fn AppWithRoutes() -> impl IntoView {
                 <Route path=path!("/test_page") view=TestPage/>
                 <Route path=path!("/comparison") view=ComparisonTestPage />
                 <Route path=path!("/providers") view=ProviderPortal/>
+                <Route path=path!("/providers/contact") view=ProviderContactPage />
                 <ParentRoute path=path!("/providers/scholarships") view=ScholarshipInfoPage>
                     <Route path=path!(":id") view=ScholarshipInfoPage/>
                     <Route path=path!("") view=ScholarshipInfoPage/>
diff --git a/src/pages/mod.rs b/src/pages/mod.rs
index b3d9f41..4da8c68 100644
--- a/src/pages/mod.rs
+++ b/src/pages/mod.rs
@@ -8,8 +8,9 @@ mod scholarship_info;
 mod test_page;
 mod unauthenticated_page;
 mod utils;
+mod provider_contact;
 
 pub use self::{
     about_page::*, comparison_test::*, home_page::*, loaner_page::*, provider_portal::*,
-    test_page::*, unauthenticated_page::*, scholarship_info::*
+    test_page::*, unauthenticated_page::*, scholarship_info::*, provider_contact::*
 };
diff --git a/src/pages/provider_contact.rs b/src/pages/provider_contact.rs
new file mode 100644
index 0000000..775d3c3
--- /dev/null
+++ b/src/pages/provider_contact.rs
@@ -0,0 +1,207 @@
+use std::collections::HashMap;
+use leptos::logging::log;
+use leptos::prelude::*;
+use leptos_oidc::{AuthLoaded, Authenticated};
+use crate::common::ValueType;
+use crate::components::{Banner, Loading, OutlinedTextField, Panel, Row, TextFieldType, ValidatedForm};
+use crate::pages::UnauthenticatedPage;
+use crate::pages::utils::get_user_claims;
+
+#[cfg(feature = "ssr")]
+use crate::pages::utils::server_utils::create_dynamo_client;
+
+#[cfg(feature = "ssr")]
+fn into_attr_map(map: HashMap<String, ValueType>) -> HashMap<String, aws_sdk_dynamodb::types::AttributeValue> {
+    map.into_iter().map(|(k, v)| (k, v.into())).collect()
+}
+
+#[server]
+async fn get_provider_contact(id: String) -> Result<HashMap<String, ValueType>, ServerFnError> {
+    use aws_sdk_dynamodb::types::AttributeValue;
+    use aws_sdk_dynamodb::error::ProvideErrorMetadata;
+
+    let client = create_dynamo_client().await;
+
+    log!("Getting contact info for provider {}", id);
+
+    match client
+        .get_item()
+        .table_name("leptos-provider-contacts")
+        .key("subject", AttributeValue::S(id))
+        .send()
+        .await
+    {
+        Ok(output) => {
+            let Some(item) = output.item else {
+                return Ok(HashMap::new());
+            };
+
+            let map = item.iter().map(|(key, val)| {
+                let val_type = ValueType::from(val);
+
+                (key.clone(), val_type)
+            }).collect::<HashMap<String, ValueType>>();
+
+            Ok(map)
+        }
+        Err(err) => {
+            let msg = err.message().unwrap_or("An unknown error occurred.");
+            Err(ServerFnError::new(msg))
+        }
+    }
+}
+
+#[server]
+async fn put_provider_contact(id: String, contact_info: HashMap<String, ValueType>) -> Result<(), ServerFnError> {
+    use aws_sdk_dynamodb::error::ProvideErrorMetadata;
+
+    let client = create_dynamo_client().await;
+
+    let mut item = into_attr_map(contact_info);
+    item.insert("subject".to_owned(), aws_sdk_dynamodb::types::AttributeValue::S(id));
+
+    match client
+        .put_item()
+        .table_name("leptos-provider-contacts")
+        .set_item(Some(item))
+        .send()
+        .await
+    {
+        Ok(_) => Ok(()),
+        Err(err) => {
+            let msg = err.message().unwrap_or("An unknown error occurred.");
+            Err(ServerFnError::new(msg))
+        }
+    }
+}
+
+#[component]
+pub fn ProviderContactPage() -> impl IntoView {
+    // Get user claims
+    let user_claims = get_user_claims();
+    let user_id = Memo::new(move |_| {
+        user_claims.get()
+            .map(|info| info.claims.subject.clone())
+    });
+
+    // Get contact information
+    let contact_info = RwSignal::new(HashMap::new());
+    let contact_resource = Resource::new(
+        move || user_id.get(),
+        async move |id| {
+            let Some(id) = id else {
+                return Ok(HashMap::new());
+            };
+
+            get_provider_contact(id).await
+        }
+    );
+
+    Effect::new(move || {
+        match contact_resource.get() {
+            Some(Ok(map)) => contact_info.set(map),
+            Some(Err(e)) => log!("Error getting contact info: {}", e),
+            None => log!("Contact info resource is not ready yet."),
+        }
+    });
+
+    // Set up submit action
+    let submit_action = ServerAction::<PutProviderContact>::new();
+
+    let on_submit = move || {
+        // Submit the form by reading the contact_info.
+        submit_action.dispatch(PutProviderContact {
+            id: user_id.get().unwrap_or_default(),
+            contact_info: contact_info.get()
+        });
+    };
+
+    let elements_disabled = Signal::derive(move || {
+        submit_action.pending().get()
+    });
+
+    // Display contact form.
+    view! {
+        <Banner
+            title="R15 Scholarships"
+            logo="/PHS_Stacked_Acronym.png"
+            path="/"
+        />
+        <AuthLoaded fallback=Loading>
+            <Authenticated unauthenticated=UnauthenticatedPage>
+                <Suspense fallback=Loading>
+                    <Panel>
+                        <ValidatedForm on_submit=on_submit>
+                            {move || contact_resource.get()
+                                .map(|_| {
+                                    view! {
+                                        <Row>
+                                            <OutlinedTextField
+                                                label="First Name:"
+                                                placeholder="John"
+                                                disabled=elements_disabled
+                                                data_member="first_name"
+                                                data_map=contact_info
+                                                required=true
+                                            />
+                                            <OutlinedTextField
+                                                label="Last Name:"
+                                                placeholder="Smith"
+                                                disabled=elements_disabled
+                                                data_member="last_name"
+                                                data_map=contact_info
+                                                required=true
+                                            />
+                                        </Row>
+                                        <Row>
+                                            <OutlinedTextField
+                                                label="Contact Email:"
+                                                placeholder="student@region15.org"
+                                                disabled=elements_disabled
+                                                data_member="contact_email"
+                                                data_map=contact_info
+                                                input_type=TextFieldType::Email
+                                                required=true
+                                            />
+                                        </Row>
+                                        <Row>
+                                            <OutlinedTextField
+                                                label="Phone Number:"
+                                                placeholder="123-456-7890"
+                                                disabled=elements_disabled
+                                                data_member="phone_number"
+                                                data_map=contact_info
+                                                required=true
+                                            />
+                                        </Row>
+                                        <Row>
+                                            <OutlinedTextField
+                                                label="Street Address:"
+                                                placeholder="123 Fake Street"
+                                                disabled=elements_disabled
+                                                data_member="address"
+                                                data_map=contact_info
+                                                required=true
+                                            />
+                                        </Row>
+                                        <Row>
+                                            <OutlinedTextField
+                                                label="Testing Number"
+                                                placeholder="Just put a number"
+                                                disabled=elements_disabled
+                                                data_member="testing_number"
+                                                data_map=contact_info
+                                                input_type=TextFieldType::Number
+                                                required=true
+                                            />
+                                        </Row>
+                                    }
+                                })
+                            }
+                        </ValidatedForm>
+                    </Panel>
+                </Suspense>
+            </Authenticated>
+        </AuthLoaded>
+    }
+}
\ No newline at end of file